Pelvic girdle pain (PGP) in pregnancy: symptoms and management
Pelvic girdle pain, often shortened to PGP, is pain felt in and around the pelvis during pregnancy. It is sometimes referred to by an older term, symphysis pubis dysfunction (SPD), though PGP is now the preferred name because it more accurately describes the range of joints and areas that can be affected. The condition is a recognised and common pregnancy complaint, and there are practical steps, including physiotherapy, supportive equipment, and adjustments to everyday movement, that can make a real difference to how it feels day to day.
What is pelvic girdle pain?
The pelvis is made up of several bones held together by joints and ligaments. During pregnancy, the body produces a hormone called relaxin, which softens and loosens these ligaments to allow the pelvis to widen gradually in preparation for birth. For most people this process happens without noticeable difficulty, but for others the increased mobility in the pelvic joints causes them to move unevenly or less smoothly than usual. That irregular movement is what creates the pain and discomfort associated with PGP.
The pain itself can appear in various locations depending on which joints are most affected. Common sites include the pubic area at the front, the lower back, the hips, the groin, the inner thighs, and the buttocks. Some people also notice a clicking or grinding sensation as they move. The experience varies considerably from person to person: for some it is a mild ache that comes and goes, while for others it can be sharp enough to limit walking and daily activities significantly.
When does it start and who does it affect?
PGP can develop at any stage of pregnancy, but it tends to be reported more often in the second and third trimesters as the pregnancy progresses and the body accommodates a growing baby. It is not a sign that something has gone wrong with the pregnancy itself, and it does not reflect anything the person has done or failed to do. The underlying cause relates to the hormonal and physical changes of pregnancy rather than any particular lifestyle factor.
The condition is more common than many people realise. Because it varies so widely in severity, milder cases are sometimes put down to general pregnancy discomfort and not reported to a midwife. If you are experiencing pelvic pain that is affecting your daily life, it is worth raising it at your next antenatal appointment or contacting your midwifery team, because physiotherapy referral and practical advice can help considerably.
Recognising the symptoms
PGP produces a characteristic pattern of pain that is typically made worse by specific movements rather than being constant. Understanding which activities tend to aggravate the pain can help both in managing it day to day and in describing it clearly to a healthcare professional. Movements that commonly worsen symptoms include:
- Walking, particularly over longer distances or on uneven surfaces
- Climbing stairs or stepping over objects
- Turning over in bed
- Getting in or out of a car
- Standing on one leg, for example when getting dressed
- Standing or sitting for long periods in the same position
The pain may be felt more on one side than the other, or it may be felt symmetrically across both sides of the pelvis. Some people find that it is worse at particular times of day, such as after a period of rest or towards the end of the day when muscles and joints are more fatigued. If you notice a clicking or grinding sensation around the pubic area or lower back when you move, that too can be part of PGP and is worth mentioning to your midwife.
Physiotherapy: the most effective approach
A referral to a physiotherapist with experience in pelvic health during pregnancy is the most useful thing your midwife or GP can arrange for you. A physiotherapist will assess your specific situation, identify which joints are causing problems, and provide a tailored plan. This typically includes exercises to strengthen the muscles that support the pelvis, advice on posture, and guidance on how to modify daily activities to reduce strain on the affected joints.
It is worth being aware that not all general exercise advice given in pregnancy is appropriate when PGP is present. Some movements that are often recommended in pregnancy, such as wide-legged stretches or certain yoga positions, can increase strain on already compromised pelvic joints. A pelvic physiotherapist will be able to advise which activities are helpful and which to avoid based on your specific assessment, rather than general guidance.
In more severe cases, a physiotherapist may also recommend a pelvic support belt. These belts are worn around the hips and work by providing additional stability to the sacroiliac joints at the back of the pelvis. They are not appropriate for everyone and work best when fitted properly, so they should be used under guidance rather than purchased and worn without assessment. Where pain is significantly affecting mobility, crutches may also be recommended to reduce the load going through one leg at a time.
Practical adaptations at home
Alongside any treatment or physiotherapy, a number of simple adjustments to everyday movements can reduce the strain on the pelvic joints and help keep symptoms more manageable. The general principle is to keep the legs together and the movements as symmetrical as possible, which reduces the twisting and rotational forces that can aggravate PGP.
When getting into or out of a car, turn to face forward so that both legs move together, rather than stepping in one foot at a time. Sitting down on the seat first and then swinging both legs in together is a technique that many people with PGP find reduces pain significantly during what is otherwise a very common trigger movement.
In bed, sleeping with a pillow between the knees can help keep the pelvis in a more neutral position and reduce discomfort during the night. Turning over in bed is often one of the most painful moments for people with PGP: bending the knees, keeping them together, and rolling as a unit rather than allowing the legs to move independently can make turning much more comfortable.
Where possible, try to avoid activities that require you to stand on one leg or to move one leg independently of the other, particularly for any sustained period. Sitting down to get dressed, using a chair or step to get in and out of the bath, and taking stairs one at a time with both feet on each step before moving to the next are all small changes that can reduce symptom flare-ups. Minimising the amount of stair climbing in a day, if your home allows for this, is also a sensible approach during a period when symptoms are acute.
PGP and your birth
Having pelvic girdle pain does not mean you cannot give birth vaginally. It does mean that your birth team needs to know about your condition so that positions and movement during labour can be planned in a way that avoids aggravating the pelvic joints. Discuss your symptoms with your midwife well before your due date, and consider documenting your pain-free range of movement so that the team attending your birth has a clear reference point for what is comfortable.
A physiotherapist can also advise on birth positions that are likely to work well given your specific presentation of PGP. Being informed and having a clear conversation with your midwifery team in advance gives you the best chance of managing the birth in a way that accounts for your pain and keeps you as comfortable as possible.
After the birth
For the majority of people, pelvic girdle pain improves after the baby is born as hormone levels shift and the body gradually returns to its pre-pregnancy state. Recovery can take a few weeks or a few months depending on how severe the PGP was and how the birth itself went. In a small number of cases symptoms persist beyond the early postnatal period, and in those situations a referral to a postnatal physiotherapist remains the right step. Continuing with the exercises and movement adaptations advised during pregnancy can support recovery in the weeks after birth.
Frequently asked questions
What causes pelvic girdle pain in pregnancy?
PGP is linked to changes in how the pelvic joints move during pregnancy. The hormone relaxin loosens pelvic ligaments in preparation for birth, and in some people this causes the joints to become unstable and painful.
When does pelvic girdle pain start?
PGP can begin at any point in pregnancy, but is more commonly reported in the second and third trimesters. It varies widely in severity, from mild discomfort to significant pain affecting daily activities.
Will pelvic girdle pain affect my birth?
PGP does not automatically mean you cannot have a vaginal birth. Discuss your symptoms with your midwife and a physiotherapist so your birth team knows what positions and movements cause pain.
Does PGP go away after birth?
For most people, pelvic girdle pain resolves after the baby is born, usually within weeks to months. A small number experience ongoing symptoms, in which case postnatal physiotherapy can help.
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